Minimally invasive laparoscopic hernia repair procedures are well known in the art. In such procedures, the surgeon is able to remotely repair a body wall tissue defect, such as a hernia, by using conventional laparoscopic surgical techniques, including the insertion of trocar cannulas through the body wall for access to the defect site, the use of a camera for remote visualization, and the use of specially designed laparoscopic surgical tools and instruments to effect the repair. Tissue repair implants have also been specially designed for such laparoscopic procedures. The use of minimally invasive laparoscopic and endoscopic surgical procedures has been found to have many documented patient benefits and advantages when compared to conventional open surgical procedures. The benefits and advantages include minimal incisions through the body wall, reduced scarring, reduced duration of the procedure and concomitant time under anesthesia, decreased opportunity for contamination of the surgical repair site with pathogens resulting in a lower incidence of hospital acquired infections, reduced pain, reduced length stay in the hospital, faster recovery time, and reduced overall costs associated with the procedure.
In a conventional endoscopic or laparoscopic ventral hernia repair procedure, the patient is anesthetized and prepared in a conventional manner. A Veress needle attached to a carbon dioxide gas source is inserted through the patient's body wall and the patient's abdominal cavity is insufflated sufficiently to provide an effective volumetric space between the body wall and the underlying viscera for both viewing and performing the surgical procedure. Next, several conventional trocar and trocar cannula combinations are penetrated through the body wall and the trocars are then withdrawn and removed from the cannulas. The cannulas serve as access ports for the insertion and removal of surgical instruments and tools, laparoscopes, various medical devices, implants, etc. A flat hernia tissue repair patch, typically mesh, is rolled or folded and inserted through the cannula and placed proximate to the hernia defect. The surgeon uses laparoscopic grasping tools to unroll or unfold the repair patch implant and place it over the hernia defect on the peritoneum. This aspect of the procedure is critical in that the implant needs to be substantially flat prior to fixation to the body wall in order to provide for an acceptable repair. The surgeon then passes several stay sutures, which were pre-mounted to the repair patch, through the abdominal wall to secure the implant over the hernia defect prior to tacking. The securement of the stay sutures requires that several open incisions be made to the exterior of the patient's body wall about the hernia or body wall defect. The surgeon then typically passes the distal end of a conventional suture passer through the partial incisions and into the patient's body cavity to retrieve the legs of each stay suture. Two passes through each incision and through the body wall are required to capture both legs of a stay suture and move them to the exterior of the body wall for securement. The legs of each suture are tensioned and are knotted together such that the knot is contained within the incision. Next, the implant is affixed to the peritoneum and body wall using a conventional laparoscopic surgical tacking instrument to complete the body wall defect repair. The procedure is completed by removing the cannulas and closing the trocar wounds, and, suturing or otherwise approximating the incisions for the stay sutures.
There is a continuing need in this art for novel and improved systems and methods for performing laparoscopic hernia repair surgical procedures such as ventral hernia repair procedures. In particular, there is a need for devices which assist the surgeon in unrolling or unfolding a tissue repair implant and maintaining the implant in a flat configuration next to the peritoneum and body wall. There is also a need to reduce the number of or eliminate stay sutures required to position a tissue repair implant prior to affixation to the peritoneum and abdominal wall in order to minimize trauma to the patient's body wall, and eliminate unnecessary incisions and associated complications such as infections and scarring.